The purpose of this study was to investigate the factors that affect the postoperative speech results in 22q11.2 delete syndrome. All patients were identified as having chromosome abnormality based on fluorescence in situ hybridization analysis.
In 25 patients, 9 children were submucous cleft palate (SMCP) and 16 were congenital velopharyngeal insufficiency (CVPI). All patients had velopharyngeal insufficiency(VPI)and had undergone pharyngeal flap operation at a mean age of 62 months.
Regarding VP closure, 19 patients showed improved VPI (normal VP group) and the other six patients did not show improved VPI (VPI group). Regarding speech results, nine were normal speech (normal speech group), and the other 16 were abnormal speech (abnormal speech group) in conversation.
The comparison points were as follows: average age of operation, IQ, presence of congenital heart diseases, amount of complications, monthly age of head control, monthly age of initial walking, monthly age of initial words, and ability to produce plosive sounds with nostril closure at pre-operation.
As a result, there was no significant difference in the average age of operation, both by VP group comparison and speech group comparison. Furthermore, there were no significant differences between the normal VP group and VPI group in other comparison points. On the other hand, there were significant differences between the normal speech group and abnormal speech group in the comparison points of IQ, head control, amount of complications and ability to produce plosive sounds with nostril closure at pre-operation. These results suggest that the prognosis of pharyngeal flap operation for these patients for VPI depends on IQ, age of head control, amount of complications, and ability to produce plosive sounds with nostril closure at pre-operation.

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The purpose of this study was to clarify the difference of velopharyngeal growth between patients undergoing pharyngeal flap surgery and those without pharyngeal surgery, and to examine the stability of the levels of velopharyngeal closure. Thirty cleft palate patients were divided into two groups, the pharyngeal flap surgery group (ph+ group) and the without pharyngeal flap surgery group (ph− group). Data were based on lateral X-ray cephalograms taken during phonation of "A". Vertical and horizontal measurements derived from various anatomic reference points and lines of the nasopharyngeal structures were analyzed.
The results were as follows:
1) There was no significant difference between the two groups; they showed similar nasopharyngeal growth in the caudal and dorsal directions.
2) No significant difference was found in the growth volume between the ph+ and ph− groups.
3) The base of the pharyngeal flap increased about 5 mm during the examination period.
4) The level of velopharyngeal closure was stable during the examination period.

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In this study, the oral environment of young patients with cleft lip and/or palate was compared with that of young children without craniofacial anomalies using a saliva test. Analysis was also carried out on the effect on the oral environment of occlusal growth and the presence of an oro-nasal fistula.
Materials: The subjects were 94 patients with cleft lip and/or palate aged 4 to 6 years visiting the Clinic for Maxillo-Oral Disorders, Tohoku University Hospital Dental Center, Japan, to manage occlusion (patient group), and 142 children without craniofacial anomalies matched for age attending a nursery in Miyagi Prefecture, Japan (non-patient group). All subjects underwent a saliva test (Dentocult^®SM, Dentocult^®LB and Dentobuff^®strip; Orion Diagnostica, Espoo, Finland). Data from the saliva test was scored according to Streptococcus mutans (SM score), Lactobacilli (LB score), saliva pH and saliva volume. Comparisons were made between the patient and non-patient groups; and within the patient group, among three groups of Hellman's Dental Age with different cleft types, patients with and without oro-nasal fistula, and patients using and not-using orthodontic appliances. Comparisons were made based on average SM scores, LB scores and saliva pH and the average scores and average numerical data of saliva volume using the Kruskal-Wallis and Mann-Whitney U tests for statistical analysis.
Results: The average SM score, LB score and saliva pH were significantly different between the patient and non-patient groups, but no significant difference was seen in the comparisons between patients within the patient group. There were no significant differences in the average score of saliva volume and average numerical saliva volume between any groups. Scores between patients with and without oro-nasal fistula were not significant, and neither the use of orthodontic appliances nor cleft type was significant.

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Crossbite type was determined in 84 patients with cleft lip and/or palate who were first examined between the ages of 6-8 years at the Department of Orthodontics, Tokyo Dental College Suidobashi Hospital.
1. Of the 84 patients, 85.7% showed crossbite at one or more sites. The most common type of crossbite was Type A(28.6%), followed by Type ABP (25.0%), Type AUP (23.8%), Type BP (4.8%) and Type UP (3.6%).
2. The most common type of crossbite by cleft type was Type AUP in unilateral cleft lip and palate (50%), Type ABP in bilateral cleft lip and palate (35.7%), Type A in unilateral cleft lip and alveolus and unilateral cleft lip (54.5% and 66.7%, respectively), and Types A and ABP in cleft palate (30.0% each).
3. Incidence of crossbite at one or more sites was highest in cases of unilateral cleft lip and palate (100%), followed by bilateral cleft lip and palate (92.9%), cleft palate (90.0%), unilateral cleft lip and alveolus (72.7%) and unilateral cleft lip (66.7%).
4. The highest incidence of crossbite was on the affected side in cases with unilateral cleft lip and palate in the anterior teeth, deciduous canines, and deciduous molar regions. The lowest incidence of crossbite was on the healthy side in cases with unilateral cleft lip in the anterior teeth, on the healthy and affected sides in cases of unilateral cleft lip and on the healthy side in unilateral cleft lip and alveolus in deciduous canines and deciduous molars (0%).
5. On the healthy and affected sides in unilateral cleft lip and palate and the affected side in unilateral cleft lip and alveolus, successive decreases in the incidence of crossbite were observed from the anterior teeth towards the molar region. In bilateral cleft lip and palate, however, the deciduous canines were placed higher than the anterior teeth. In cleft palate, the deciduous molars were placed higher than the deciduous canines.
In this study, crossbite type was determined according to the classification of Kitabayashi with modifications together with incidence by affected side and site of cleft. The results clarified the characteristic crossbite type and its incidence for each of the conditions studied.

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A clinico-statistical investigation was conducted with 1112 cleft lip and/or palate patients (excluded 18 cases in which data were inadequate) in the Cleft Lip and Palate Center, Fujita Health University Hospital, since its foundation in April 1992.
The results were as follows:
1) Primary cases were 1073, secondary cases were 39, and average number of patients registered per year was 75.5 from 1993 to 2006.
2) The distribution by cleft type was: 368 cases (33.1%) with unilateral CL (A) P, 279 cases (25.1%) with unilateral CL (A), 275 cases (24.7%) with CP, 157 cases (14.1%) with bilateral CL (A) P, 26 cases (2.3%) with bilateral CL (A), and 7 cases (0.6%) with others.
3) The average number of operations per year from 1993 to 2006 was as follows: chelioplasty (primary lip operation) 61.7, palatoplasty (one stage operation for CP) 13.1, palatoplasty (soft palate in two stage operation) 26.5, palatoplasty (hard palate in two stage operation) 23.4, secondary alveolar bone graft 17.8, and secondary operation for velopharyngeal incompetence 3.
4) The number of patients registered for speech evaluation and training was 741 until June 2007.

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A clinico-statistical study was performed on patients with cleft lip and/or palate in the past 26 years at the Department of Oral and Maxillofacial Surgery, Saga Medical School.
The results were as follows:
1. The total number of patients was 502.
2. The patients were 267 males and 235 females, with a male to female ratio of 1.13 : 1.
3. The number of primary cases was 258, and that of secondary cases was 244.
4. Cleft morphology was classified as follows: cleft lip, alveolus and palate in 298 (59.3%), cleft lip and alveolus in 77 (15.3%), cleft lip in 71 (14.1%), and cleft palate in 56 (11.1%).
5. The laterality in cleft lip in 446 cases was unilateral in 357 cases, and bilateral in 89 cases. The left-right ratio of the cleft side in unilateral cleft cases was 1.3 : 1.
6. Most patients (69.4%) were residents of Saga prefecture among primary cases, but patients resident in Fukuoka prefecture accounted for the greatest proportion (65.2%) in secondary cases.
7. The frequency of familial expression was 3.6%.
8. Other congenital anomalies and/or disorders were found to be associated in 113 cases (22.5%), and they were more frequently found in cleft palate patients (41.1%).
9. The total number of surgical operations was 907.

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Early postoperative home care after pediatric surgery, including primary cleft lip repairs, allows both the patients and the parents to be in a more comfortable and familiar environment. Therefore, we have been performing primary cleft lip repairs using a clinical pathway with a 3-day hospital stay since September 2006.
The features of our clinical pathway are as follows:
1: Avoiding suture removal by using absorbable sutures for closure of the vermilion mucosa and deep dermal layer, and applying Dermabond^® for skin adhesion.
2: Usual sucking is allowed after 3 hours.
3: Intravenous hydration is finished on the day of the operation, if possible.
4: Intravenous antibiotics are administrated only during the operation.
5: No arm restrictions are used.
We retrospectively reviewed 96 patients who underwent primary cleft lip repairs from 1998 to 2008. The patients were divided into two groups: patients with no clinical pathway from 1998 to 2006(group 1), and those managed with the clinical pathway from 2006 to 2008(group 2). Parameters considered for each group were length of hospital stay and complications within 2 weeks of operation.
The average length of hospital stay was 6.8 days in group 1 and 3.0 days in group 2. There was no significant difference between the groups in complication rate(p < 0.05).
Our data support the safety of primary cleft lip repair performed with a 3-day hospital stay and the efficacy of our clinical pathway.

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Occlusal re-construction was non-prosthetically achieved in a case of bilateral cleft lip and palate with antero-lateral stenosis of the maxillary dentition, without performing lateral expansion. Changes in the maxillary dental arch width were evaluated. This paper reports on the treatment course and occlusal stability.
The patient was a female with bilateral cleft lip and palate showing skeletal mandibular protrusion due to maxillary hypo-growth with protrusion and inferior descent of the intermediate jaw. Although lateral expansion was performed in the growth period, relapse occurred thereafter. Therefore, at the final treatment, surgical orthodontic treatment with Le Fort type I osteotomy was performed to improve the overlap, without expanding the maxillary dental arch width. Furthermore, the canines were arranged in the bilateral alveolar cleft areas to establish occlusion. Serial evaluation confirmed that the maxillary dentition width at the time of the initiation of retention remained the same at the time of re-diagnosis, showing occlusal stability.

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